Innovations in Assessing ADHD: Development, Psychometric Properties, and Factor Structure of the ADHD Symptoms Rating Scale (ADHD-SRS)

This research involved the development of a behavior rating scale designed to measure ADHD and the investigation of the scale's psychometric properties and factor structure. This scale, the ADHD Symptoms Rating Scale (ADHD-SRS), was developed for the assessment of ADHD in the school-age (K–12) population. Participants were 1006 children and adolescents (in grades K–12) who were rated by their parents and/or teachers. The results indicate that the ADHD-SRS possesses strong internal consistency reliability and test–retest reliability and moderate cross-informant reliability. The data also suggest that the ADHD-SRS has strong content validity. Convergent validity of this instrument was also high, as demonstrated by correlations with three previously validated behavior rating scales. Significant age and gender differences in ADHD symptoms were found with both the parent and teacher respondent populations. Finally, the factor analysis of the ADHD-SRS suggested a two factor oblique rotation as the best fit for both the parent and the teacher data. After a visual inspection of the items which loaded on each factor, Factor 1 was named Hyperactive-Impulsive and Factor 2 was named Inattention. These two factors, along with the items which loaded on each factor, appear to be remarkably similar to the two categories listed in the DSM-IV for ADHD. Directions for future research, as well as clinical implications and limitations of the research are discussed.     

Executive Functioning, Temporal Discounting, and Sense of Time in Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD)

Clinic-referred teens (ages 12–19) with ADHD and ODD (N = 101) were compared to community control (CC) teens, equated for age and sex, (N = 39) on a variety of psychological tasks assessing executive functioning (EF), temporal reward discounting, and time estimation and reproduction. A factor analysis reduced the EF measures to three dimensions, representing CPT Inattention, Working Memory, and CPT Inhibition. Results indicated that the ADHD group had significantly more CPT Inattention than the CC group. No differences were found for Working Memory or CPT Inhibition. The ADHD group displayed significantly greater temporal discounting of delayed hypothetical monetary rewards relative to immediate ones and manifested more impaired time reproduction, but not time estimation, than did the CC group. Main effects for level of IQ were found only on the Working Memory factor and largely did not interact with the group factor otherwise. The group differences in CPT Inattention, temporal discounting, and time reproduction were not a function of level of comorbid oppositional defiant disorder, delinquency, or anxiety–depression. Results are reasonably consistent with past research on EF and sense of time in children with ADHD and extend these findings to the adolescent age group. Problems with working memory and CPT inhibition found in prior studies of children with ADHD, however, were not evident here, perhaps owing to age-related improvements or insufficient task difficulty.     

Treatment Sensitivity of a Brief Rating Scale for Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms

This study examined the treatment sensitivity of the ADHD Questionnaire (ADHD-Q), which is a brief rating scale for measuring symptoms of inattention, hyperactivity, and impulsivity in children. Parent, teacher, and child self-report data of the ADHD-Q were obtained for 17 clinically referred children with ADHD on the three occasions: (1) during the regular intake assessment, (2) just before the start of the stimulant medication (i.e., methylphenidate) intervention, and (3) four weeks after the start of the medication intervention. Results showed that ADHD-Q scores remained fairly stable in the period prior to the intervention, but then showed a substantial decline after the stimulant medication had been administered. Clearly, this finding supports the treatment sensitivity of the ADHD-Q.     

Confirmatory factor analysis of the Behavior Rating Inventory of Executive Functioning (BRIEF) in children and adolescents with ADHD

The Behavior Rating Inventory of Executive Functioning (BRIEF) is a parent report measure designed to assess executive skills in everyday life. The present study employed a confirmatory factor analysis (CFA) to evaluate three alternative models of the factor structure of the BRIEF. Given the executive functioning difficulties that commonly co-occur with attention-deficit/hyperactivity disorder (ADHD), the participants included 181 children and adolescents with a diagnosis of ADHD. The results indicated that an oblique two-factor model, in which the Monitor subscale loaded on both factors (i.e., Behavioral Regulation, Metacognition) and measurement errors for the Monitor and Inhibit subscales were allowed to correlate, provided an acceptable goodness-of-fit to the data. This two-factor model is consistent with previous research indicating that the Monitor subscale reflects two dimensions (i.e., monitoring of task-related activities and monitoring of personal behavioral activities) and thus loads on multiple factors. These findings support the clinical relevance of the BRIEF in children with ADHD, as well as the multidimensional nature of executive functioning.     

“热”执行对注意缺陷多动障碍和阅读障碍儿童言语工作记忆的影响

ADHD儿童在与背外侧前额叶(DLPFC)相关的"冷"执行功能上的缺陷已大量证实,但在与眼眶和中前额叶皮层(OMPFC)相关的"热"执行功能上,ADHD儿童是否存在缺陷则未可知。与儿童赌博任务实验范式(该任务中"热"启动对"冷"执行起到抑制作用)不同,本研究考察趣味言语N-back任务是否对ADHD和阅读障碍儿童的成绩有促进作用。枯燥N-back任务考察的是言语工作记忆的纯认知特征,而趣味任务则卷入了"热"执行对"冷"执行的影响。结果表明,在枯燥任务上,ADHD和阅读障碍儿童的成绩均明显低于正常儿童,二者之间差异不显著,在趣味任务成绩上,ADHD儿童与正常儿童的成绩没有显著差异,而阅读障碍儿童成绩落后于正常控制组和ADHD组,在成绩变化的趋势上,ADHD儿童在趣味任务上成绩明显提高,而阅读障碍儿童则无明显改善。结果说明ADHD和阅读障碍儿童的言语工作记忆均存在明显的缺陷,但是机制不同,"热"执行对提高ADHD的言语工作记忆有明显的促进作用,ADHD的"冷"执行缺陷能够通过"热"执行的调节得到改善。     

Revision and Restandardization of the Conners Teacher Rating Scale (CTRS-R): Factor Structure, Reliability, and Criterion Validity

The Conners Teacher Rating Scale (CTRS) is a commonly used research and clinical tool for assessing children's behavior in the classroom. The present study introduces the revised CTRS (CTRS-R) which improves on the original CTRS by (1) establishing normative data from a large, representative North American sample, (2) deriving a factor structure using advanced statistical techniques, and (3) updating the item content to reflect current conceptualizations of childhood disorders. Using confirmatory factor analysis, a six-factor structure was found which includes Hyperactivity-Impulsivity, Perfectionism, Inattention/Cognitive Problems, Social Problems, Oppositionality, and Anxious/Shy factors. The reliability of the scale, as measured by test-retest correlations and internal consistency, is generally satisfactory. Using all of the scale factors to discriminate between attention deficit hyperactivity disordered and normal children, 85 percent of children were correctly classified, supporting the validity of the scale and indicating excellent clinical utility. Similarities and differences between the original CTRS factor structure and the CTRS-R factor structure are discussed.     

钟面画测试及其在ADHD儿童中的研究

钟面画测试被广泛用于研究和测试老年人群中的各种认知缺陷和认知老化,是一种有用的筛选老年痴呆症病人的工具。近年来它也被用于研究正常儿童和ADHD儿童。该文回顾了钟面画测试所涉及的内部认知过程以及影响钟面画测试的各种因素、钟面画测试与执行功能测试之间的相关,并且重点回顾了钟面画测试在正常儿童和ADHD儿童中的研究。由于钟面画测试本身简便、快捷,可以迅速地大规模筛选障碍儿童,在这方面的研究具有重大的实践意义。     

Executive functioning deficits in relation to symptoms of ADHD and/or ODD in preschool children

The present study investigated the relation between executive functioning and symptoms of Attention‐Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) in children aged 4–6. A population‐based sample (n=201) was used and laboratory measures of inhibition, working memory and verbal fluency and teacher ratings of disruptive behaviour problems were collected. Both group differences and linear relations were studied and comorbidity was controlled for dimensionally. In both categorical and dimensional analyses, executive functioning was associated with symptoms of ADHD, but not with symptoms of ODD when controlling for comorbidity, and no significant interactive effects of ADHD and ODD symptoms were found. Effect sizes for significant effects were generally in the medium range. Regarding sex differences, the control for comorbid ODD symptoms appeared to affect the relation between ADHD symptoms and executive functioning somewhat more for girls compared with boys. In conclusion, poor executive functioning in preschool appears to be primarily related to symptoms of ADHD, whereas the relation to symptoms of ODD can be attributed to the large overlap between these two disruptive disorders. Copyright © 2006 John Wiley & Sons, Ltd.     

The Revised Conners' Parent Rating Scale (CPRS-R): Factor Structure, Reliability, and Criterion Validity

The Conners' Parent Rating Scale (CPRS) is a popular research and clinical tool for obtaining parental reports of childhood behavior problems. The present study introduces a revised CPRS (CPRS-R) which has norms derived from a large, representative sample of North American children, uses confirmatory factor analysis to develop a definitive factor structure, and has an updated item content to reflect recent knowledge and developments concerning childhood behavior problems. Exploratory and confirmatory factor-analytic results revealed a seven-factor model including the following factors: Cognitive Problems, Oppositional, Hyperactivity-Impulsivity, Anxious-Shy, Perfectionism, Social Problems, and Psychosomatic. The psychometric properties of the revised scale appear adequate as demonstrated by good internal reliability coefficients, high test-retest reliability, and effective discriminatory power. Advantages of the CPRS-R include a corresponding factor structure with the Conners' Teacher Rating Scale—Revised and comprehensive symptom coverage for attention deficit hyperactivity disorder (ADHD) and related disorders. Factor congruence with the original CPRS as well as similarities with other parent rating scales are discussed.     

Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function (BRIEF): Support for a distinction between Emotional and Behavioral Regulation

Previous research has supported a three-factor division of the Behavior Rating Inventory of Executive Function (BRIEF) when dividing the parent form in 9 instead of 8 subscales. The present study investigated different factor models in the 8- and 9-scale division in both the parent and teacher form of the Norwegian BRIEF version. Confirmatory Factor Analyzes showed best fit for the three-factor model in a mixed healthy and clinical sample, indicating a distinction between Emotional and Behavioral Regulation. This division is in accordance with present knowledge of brain function and may increase the specificity of executive dysfunction in clinical groups.     

Factorial validity of the Behavior Rating Inventory of Executive Function (BRIEF)-Teacher form

Deficits in executive function (self-regulatory mechanisms) have been linked with many childhood disorders including attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and conduct disorder. Executive functioning is typically assessed by individually administering performance-based measures in a clinical setting. However, performance-based methods are inefficient for school psychologists. A more feasibly implemented measure for applied settings is the Behavior Rating Inventory of Executive Function (BRIEF), but researchers have raised questions about the internal validity and the proposed factors. In this study, we examined the factor structure of the teacher form of the BRIEF in a sample of 2,044 general education elementary students and 131 teachers in a multilevel design. Results revealed support for a model with three factors at Level 1 and one general factor at Level 2. The results of our study do not support the current two-factor model of the published BRIEF protocol.     

Parent and Teacher Ratings of Attention-Deficit/Hyperactivity Disorder in Preschool: The ADHD Rating Scale-IV Preschool Version

Efforts for early identification and intervention for children with AD/HD have necessitated the development of rating scales of behavior for the preschool population. The standardization, reliability, and validity data were presented for the ADHD Rating Scale-IV Preschool Version. Parent and teacher ratings were collected on 902 and 977 children 3 to 5 years of age, respectively. Raw scores for the Inattention, Hyperactivity/Impulsivity and Total scores were converted to T-Scores and percentile ranks. Reliability coefficients ranged from 0.80 to 0.95 indicating good test–retest reliability. Concurrent validity with the Conners Teacher Rating Scales: Revised-Short and Conners Parent Rating Scale: Revised-Short ranged from 0.54 to 0.96. The ADHD-Rating Scale-IV appears to be a reliable, valid and user friendly measure for screening preschoolers with behavior problems. Future research is needed to validate its widespread use as a screening and diagnostic tool.     

儿童注意缺陷多动障碍(ADHD)的“冷”“热”执行功能

近30多年来,对注意缺陷多动障碍(ADHD)的认知缺损机制的关注一直停留在"冷"执行功能领域,为更全面地揭示其执行缺损机制,文章旨在从"冷""热"执行功能的角度来探讨ADHD的缺陷。论文简要回顾了注意缺陷多动障碍的界定、生理基础和若干理论模型,着重阐述ADHD儿童在经典"冷""热"两类执行功能任务上的表现差异。总结认为ADHD儿童并非在所有类型的"热"执行任务上表现落后,ADHD儿童的表现要视情感和动机的卷入对不同任务情景的作用性质是消极还是积极而定,文章也比较分析了几位研究者相关的理论解释。     

Psychometric Support for an Abbreviated Version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form

The objectives of this study were to systematically develop and evaluate the psychometric properties of an abbreviated version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Report; a questionnaire widely used by pediatric neuropsychologists. A total of 24 items from the original BRIEF Parent Form were selected for the short-form, which was then evaluated in three complementary samples, according to six a priori psychometric criteria. The short-form generally demonstrated appropriate psychometric qualities, with convincing evidence for the reliability and validity of the three composite indices: Behavioral Regulation, Metacognition, and the Global Executive Composite. Potential clinical applications include screening at-risk children in medical clinics to facilitate appropriate referrals for further psychological consultation. In research settings, the short-form can be easily integrated into studies involving mass collection of data (e.g., large-scale epidemiological research), facilitating advancements in the scientific understanding of neuropsychological morbidity in medically involved populations.     

Children’s Memory for Temporal Information: The Roles of Temporal Language and Executive Function

Abstract

The ability to recall the temporal order of events develops much more slowly than the ability to recall facts about events. To explore what processes facilitate memory for temporal information, we tested 3- to 6-year-old children (N?=?40) for immediate memory of the temporal order of events from a storybook, using a visual timeline task and a yes/no recognition task. In addition, children completed tasks assessing their understanding of before and after and the executive functions of inhibition using the Day/Night Stroop task and cognitive shifting using the Dimensional Change Card Sort (DCCS) task. Older children (Mage?=?69.25?months) outperformed younger children (Mage?=?52.35?months) on all measures; however, the only significant predictor of memory for the temporal ordering of events was cognitive shifting. The findings suggest that the difficulty in memory for temporal information is related to development of a general cognitive ability, as indexed by the DCCS, rather than specific temporal abilities.     

Comorbidity of Attention Deficit Hyperactive Disorder (ADHD) and major depression in primary school children

The study investigated comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and depression in a sample of rural primary school children in Limpopo Province, South Africa. A total of 320 learners participated in this study of whom 160 learners had teacher and parent identified ADHD symptoms (females?=?50%; age range 6–14 years). All the learners took the Beck Depression Youth Inventory, second edition. Data were analysed applying ANOVA to investigate the possible differences between and within age, gender, and ADHD subtype group differences in depression symptomatology. Results indicated no statistically significant differences in the scores on the depression scale between the children with ADHD as identified by parents and teachers and the comparison group peers.     

Executive and attentional contributions to Theory of Mind deficit in attention deficit/hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) in children has been associated with attentional and executive problems, but also with socioemotional difficulties possibly associated with deficits in Theory of Mind (ToM). Socioemotional problems in ADHD are associated with more negative prognoses, notably interpersonal, educational problems, and an increased risk of developing other psychiatric disorders that emphasize the need to clarify the nature of their ToM deficits. In this study, we hypothesized that ToM dysfunction in children with ADHD is largely attributable to their attentional and/or executive deficits. Thirty-one children with ADHD (8–12 years, IQ > 85) and 31 typically developing (TD) children were assessed using executive functions (inhibition, planning, and flexibility) and attentional tasks, as well as two advanced ToM tasks (Reading the Mind in the Eyes and Faux Pas) involving different levels of executive control. Children with ADHD performed more poorly than TD children in attentional, executive function, and ToM tasks. Linear regression analyses conducted in the ADHD group indicated that inhibition scores predicted performance on the “Faux Pas” task the best, while attention scores were the best for predicting performance on the Reading the Mind in the Eyes task. When controlled for inhibition and attentional variables, ToM performance in children with ADHD was actually similar to TD children. Contrarily, controlling for ToM scores did not normalize performance for inhibition and attentional tasks in children with ADHD. This unidirectional relationship suggests that deficits in the EF and attentional domains are responsible for ToM deficits in ADHD, which therefore may contribute to their socioemotional difficulties.     

The Vigilance,Orienting, and Executive Attention Networks in 4-Year-Old Children

The present study examined the development of lower and higher order forms of attention during the preschool years. Lower forms of attention were assessed with tasks that primarily engaged the attention functions of vigilance and orienting. Higher, executive forms of attention were assessed with tasks that involved inhibition and working memory. The findings revealed that performance improved significantly with age on measures of inhibition and orienting. Results are discussed in the context of the development of attentional networks.